Bevacizumab in first-line therapy in lung metastases of colorectal cancer: An ARCAD pooled analysis.

Authors

null

Einat S Shmueli

Cancer Center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel;

Einat S Shmueli , Morteza Raeisi , Benoist Chibaudel , Herbert Hurwitz , Leonard B. Saltz , Fairooz F. Kabbinavar , Niall C. Tebbutt , Axel Grothey , Richard Adams , John Raymond Zalcberg , Takayuki Yoshino , Jean-Baptiste Bachet , Romain Cohen , Lama Sharara , Thierry Andre , Qian Shi , Aimery De Gramont

Organizations

Cancer Center, The Chaim Sheba Medical Center, Ramat Gan, Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel; , Statistical Unit, Fondation A.R.CA.D - Aide et Recherche en CAncérologie Digestive, Levallois-Perret, France; , Hopital Franco-Britannique-Fondation Cognacq-Jay, Levallois-Perret, France; , Duke Cancer Institute, Duke University, Durham, NC; , Memorial Sloan Kettering Cancer Center, New York, NY; , Pharma, Los Angeles, CA; , Department of Medical Oncology, Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia; , West Cancer Center, Germantown, TN; , Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom; , Monash University, Melbourne, VIC, Australia; , Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan; , Sorbonne University, Hepatogastroenterology and Digestive Oncology Department, Pitié Salpêtrière Hospital, APHP, Paris, France; , Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France; , Fondation A.R.CA.D.-Aide et Recherche en Cancérologie Digestive, Levallois-Perret, France; , Mayo Clinic, Rochester, MN; , Department of Medical Oncology, Franco-British Hospital, Levallois-Perret, France;

Research Funding

Other Foundation
ARCAD Foundation

Background: Anti-VEGF is widely used in the treatment (trt) of metastatic colorectal cancer (mCRC). Only studies with bevacizumab (BEV) have shown survival benefit (bnf) in first line trt. The magnitude of bnf might differ based on the metastatic (met) site and the chemotherapy regimen (CTR) with which BEV is partnered. ARCAD database contains individual patient data (IPD) of randomized trials that evaluated BEV+ CT. In this pooled analysis, we aimed to evaluate BEV bnf in mCRC with lung metastases (mets) either as single or multiple sites. Methods: IPD from four trials (AVF2107g, N016966, AVF2192g, AGITG) comparing CT +/- BEV were pooled. The primary endpoint, overall survival (OS), was estimated using Kaplan-Meier method and prognostic value of lung mets was evaluated by stratified Cox models according to number and type of met sites and CTRs, oxaliplatin or irinotecan (OX/IRI) based. The predictive bnf of BEV was evaluated by interaction test (int) between trt and lung mets status in subgroups and considered as significant (sig) with a P < 0.1. Results: 2728 patients (pts) with known met sites and survival data were pooled. 1020 pts had single met site, 133 had only lung mets. 1708 pts had multiple met sites, 1008 had lung mets. Pts characteristics were well balanced. Sig OS bnf of BEV was observed in the whole population. In pts subgroup according to the presence or absence of lung mets, sig bnf of BEV were observed with a non-sig int (Pint=.590). Non-sig bnf of BEV was observed in pts with single site regardless of met site (lung or no lung) or CTR. Sig bnf of BEV was observed in pts with multiple sites without lung mets whatever the CTRs. While sig bnf of BEV was observed in pts with multiple sites with lung mets, we found a sig int between BEV and OX/IRI-based regimens (Pint=.022). The bnf of BEV was observed with IRI-based regimen but not in OX-based regimen. The bnf of BEV appears greater in multiple sites without lung mets than with lung mets with a sig stratified log-rank test (PLRT<.001). Conclusions: In pts with multiple sites mCRC, a statistically sig OS bnf of BEV added to CT was observed mainly among pts without lung mets. The overall effect of CT partner choice when combined with BEV can be different. In pts with single site, BEV did not seem to improve OS but the evaluation of efficacy of BEV in presence or absence lung mets was based on small number of pts and needs to be evaluated in trials with larger pts sample, especially trials including pts with single site lung mets.

All pts OX-based regimen IRI-based regimen
PintN/EHR (95% CI)PintN/EHR (95% CI)PintN/EHR (95% CI)
Single site.235.224.357
lung mets133/311.2 (.58-2.5)68/151.7 (.57-4.9)46/81.5 (.36-6.3)
No lung mets887/356.81 (.66-1)504/145.89 (.64-1.2)261/130.72 (.51-1.02)
Multiple sites.388.073
.863
lung mets1008/492.81 (.68-.97)451/1621.02 (.75-1.4)349/177.62 (.46-.84)
No lung mets700/376.73 (.60-.90)375/158.70 (.51-.96)155/83.62 (.40-.96)

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Cancers of the Colon, Rectum, and Anus

Track

Colorectal Cancer,Anal Cancer

Sub Track

Therapeutics

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 118)

DOI

10.1200/JCO.2023.41.4_suppl.118

Abstract #

118

Poster Bd #

F15

Abstract Disclosures